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Ask Dr. Ed Wilfong Your Own Question
Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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Im weening off sertraline to start celexa. I went from 200mg

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I'm weening off sertraline to start celexa. I went from 200mg of sertraline and for the past week have only been taking 100mg. I am also taking .5mg of clonazepam almost every day and then at least one vicadin a day for tooth pain. I hate pills! I just want to be taking one antidepressant and not feel dizzy head, anxiety, and depression. Whats the formula I need to stick with?
First of all, the anti-depressants you are on are Zoloft and Celexa. The plan in place to taper down the Zoloft and stay on Celexa. Correct? You should ultimately only be on one. It sometimes takes some trial and patience to find the right one. Tapering the Zoloft should only take about 2 weeks.

The Vicodin as a Narcotic pain reliever. While you are using it, it can have unpredictable effects on how well antidepressant works (not dangerous, just can prevent it from working. I assume that and the Motrin are for temporary use for the tooth pain. Using motrin for migraine headaches every day can actually make the headaches worse and lead to rebound headaches. The chemicals influenced by anti-depressants is also the one addressed by the newer anti-migraine medications, such as immitrex. It cannot be taken with the antidepressants. An alternative you can use when you feel a migraine coming on is MAXALT. You put it under tongue, it dissolves and often prevents migraines. It is much more effective to be able to anticipate a migraine and prevent it than stop it after it starts. Ask your MD.

The Klonapin is a benzodiazpine and is a low dose of a minor anti-anxiety medication. It is for short term use as you will eventually need more for same effect, which is not a good cycle to get into. Often it is used only until the antidepressant starts to work.

I would hope the goal IS to to have you only on Celexa. It may be hard to tell which is working best while on Vicodin. Perhaps then, just having an as needed medication, like maxalt, for migraines will not be too many drugs.

If there is a "reason" for your depression - something bad happened or perhaps abuse in childhood, counseling will be a helpful part of treatment. Research indicates that counseling plus medication is superior to either alone, yet both can work alone, often equally well.

Edited by Dr. Ed Wilfong on 12/3/2009 at 1:06 AM EST
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Customer: replied 6 years ago.
I really appreciate your answer. I didn't taper off zoloft for two weeks. I tapered down from 200 mg to 100 in 8 days. Then today instead of taking 100 mg of zoloft, I took the 20mg of celexa. The sertaline quit working three months ago. So my depression and anxiety has stemmed primarily from that. I hope I haven't made a mistake by taking the celexa before tapering for two weeks. Both my primary and psychiatrist were out of the office today. I just want to feel better. I feel really good tonight. I hate that it has taken so many pills to make me feel this way. So. If I'm okay starting the celexa now, I take the celexa for the depression, MAXALT (otc?) for oncoming migraine but then what for the tooth pain? I have my root canal scheduled for two weeks from now. *first available.
You should be OK on just 20mg of Celexa. If you start feeling really crappy, you may need a little more time with zoloft. Sometimes I have seen MDs half the dose of each, e.g. 50 zoloft, 10mg Celexa for 4-5 days then quit zoloft and increase celexa. Combining SSRIs can be dangerous due to a very small possibility of Serotonin Syndrome. You doses would be low enough to be ok, but don't increase Celexa to 20mg before d/c zoloft. You can really quit zoloft as quickly as your body tolerates it. The taper is for your "comfort" more than anything.
The Vicodin is fine until you get teeth fixed. Just not good long term.
Maxalt is by prescription only. I hope you have good insurance. Not cheap.
Just keep on Celexa 20 unless you start feeling crappy. Your plan is actually pretty good as you will have some SSRI in system while starting Celexa and they are similar enough that you are not "starting over"

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